Humana CareSource Presentation Medical Advisory Council Meeting - - PowerPoint PPT Presentation

Humana CareSource Presentation

Medical Advisory Council Meeting

Thursday, July 25, 2019

Humana has a significant community presence in Kentucky

A diverse business profile

Insurance products and health and wellness services for individuals, businesses of all sizes and public-sector entities – all of which make it easy for people to achieve their best health.

• Medicaid
• Medicare Advantage
• DSNP coverage for dual eligible beneficiaries
• Medicare prescription drug plans

Our associates are motivated by a common purpose to improve our members’ health

89th

Percentile

Compared to other companies, Humana is at the 89th percentile on associate engagement Reduction in unhealthy days in associate population since 2012

18%

Company-wide retention rate

88%

Those we serve:

145,000

Medicaid plan members

(statewide; July 2019)

12,185

associates

(statewide, Nov 2018)

Those we employ:

101,686

Volunteer hours

(Kentucky Associates, 2018)

462

Veteran associates

(Kentucky Associates, 2018) (278 Disabled Veterans)

918,100

plan members

(statewide; Sept 2018)

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Humana’s Integrated Platform

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Humana’s integrated platform provides a seamless experience for Me Members and Pro rovid

• iders. (Effective 1/1/2020)

GOVERNANCE PROPRIETARY SOURCE CODE INTEGRATED ECOSYSTEM

* Integrated platform effective 01/01/2020

Humana’s Comprehensive Care Support Model

IDENTIFICATION

1

STRATIFICATION

2

ASSESSMENT

4

ENGAGEMENT

5

CARE PLANNING

6

OUTREACH

3

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Care Management Team

Our Approach

• Focus on assisting members with chronic illness and functional impairments, multiple co-morbidities, or at-risk pregnancies.
• Members are assessed to determine their physical, behavioral, and social needs.
• High Risk: Includes those members with chronic illness, functional impairments, multiple co-morbidities, and at-risk pregnancies.
• Rising Risk: Person or family centered approach to promote effective communication, coordination, and collaboration in a timely and

proactive manner.

• Self-Management: Members are provided with tools, resources, and education to enable them to navigate the health care system and

proactively manage their health and well-being.

• A diverse team of Registered Nurses, Masters-Prepared Social Workers, and Community Health Workers are employed to support our members.
• Seven (7) Community Health Workers have recently been hired to address needs in our vulnerable and underserved communities.
• Associates are assigned to members based on proximity to members to ensure they are familiar with local resources and are able to meet with

members in-person.

• Members are engaged in a variety of settings which include, but are not limited to, hospitals, provider offices, community agencies, and the home

to establish an effective, professional, and productive relationship.

Humana CareSource has maintained a consistent goal of driving improved quality of life for members and the communities we serve.

Clinical Quality Performance Improvement

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Key Initiatives

• Telephonic Care Gap Campaign for Preventive Cancer

Screening

• Breast, Cervical, & Colorectal cancer
• Targeted outreach to engage members in

scheduling appointments

• 23% reach rate
• Clinical Care Gaps
• Clinical Practice Registry (CPR) report developed by

HCS

• CPR report identifies care gaps for chronic

condition monitoring or preventive health screenings

• CPR report delivered to Tier 1 providers by

Provider Engagement Team

Humana CareSource has developed focused interventions and strategies to improve access to high-quality, high-value care.

Network Access

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Humana CareSource has a comprehensive and dependable network of participating providers covering all 120 Kentucky counties. Humana meets the KY Medicaid Adequacy Requirements.

OVER 2,800

primary care providers

OVER 22,000

specialist providers

OVER 130

hospitals

OVER 900

dental providers

OVER 2,600

behavioral health providers

OVER 1,150

pharmacies

Humana CareSource has assisted 1,358 providers obtain a Kentucky Medicaid ID.

Emergency Room Utilization

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• 900 members targeted through data analytics.
• Letter mailed to members identified as high utilizers (more than 4 ER visits in 12 months) referring them to a Nurse Advice Line.
• Brochure used to educate target members on appropriate use of Emergency Room, Urgent Care, and Retail Clinics. Members were also provided

with magnets which included the contact information for the Nurse Advice Line.

• Care Management and Quality Improvement teams performed outreach as part of the ACSC PIP (Ambulatory Care Sensitive Conditions) to members

with the following diagnoses, 3 or more ER visits in 4 months, and one or more care gap indicators for Diabetes, Asthma, and Heart Disease.

1Q2017 2Q2017 3Q2017 4Q2017 1Q2018 2Q2018 3Q2018 4Q2018 Emergency Room 900.0 863.2 868.0 855.8 823.9 785.3 809.8 770.6 700.0 750.0 800.0 850.0 900.0 950.0

ER Utilization per 1K Members

$15.50 $16.00 $16.50 $17.00 $17.50 $18.00 1Q2017 2Q2017 3Q2017 4Q2017 1Q2018 2Q2018 3Q2018 4Q2018

ER Per Member Per Month Costs

Medical and Pharmacy Trends

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Key Insights

• No adjustment made for member mix or

program changes.

• Medical costs are generally higher than

Pharmacy costs, resulting in the total cost

• f care trend aligning more closely with

Medical costs.

• Total cost of care increased 18.49% over

three (3) years.

• Total Pharmacy cost increased 16.67%
• ver three (3) years.
• GDR increased by 5.1%.

2015 - 2016 2016 - 2017 2017 - 2018 2018 - 2019 Medical 7.76% 12.16% 2.57% 4.38% Pharmacy 9.19% 4.04% 6.16% 6.47% Total 8.09% 10.30% 3.35% 4.84%

0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00%

Percent Increase

Average Costs

Humana CareSource is committed to improving outcomes and reducing unnecessary costs.

Humana’s Population Health Management Approach

CQI

• Use KDMS-mandated measures with the Triple-Aim Population Health Dashboard
• Leverage process and outcome measures to implement continuous quality improvement in all steps
• Track CDC Healthy Days and other SDOH & Population Health metrics
• Analyze KY data to identify population patterns, subpopulations, trends, and outliers
• Identify population cohorts with health improvement opportunities
• Prioritize improvement areas to address key population health drivers
• Set meaningful, achievable improvement targets aligned with KDMS priorities
• Align all operations: clinical, quality, payment models, and network partners to achieve goals
• Apply evidence-based strategies
• Design interventions to target unique characteristics of cohort
• Share data, educate, and train providers on population health tactics while engaging

providers where they are on a spectrum of value-based payment models

COHORT CREATION

1

EVALUATION & REPORTING

4

DESIGN INTERVENTIONS

3 2

DEFINE GOALS

Humana KY Medicaid Population Health Management Tools

METRICS

• Healthy Days
• State Data
• Clinical Outcomes

ANALYTICS

• Market Health Scorecard
• Community Health Dashboard
• Identification of Subpopulations
• Service Utilization
• Social Determinants of Health
• Provider Quality and Efficiency
• Advanced Analytics
• Predictive Models
• Centralized Data Mart

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Women and Children’s Health Program

Tar arget Po Popula latio ions and nd El Eligib ibil ility ity Requir irements

• Pregnant women up to 1 year after delivery, infants, children, adolescents and young

adults up to 21, and Women of Child Bearing Age (WCBA) 14-45.

• All Pregnant women up to 1 year after delivery, infants, children, adolescents and young

adults up to 21, and Women of Child Bearing Age (WCBA) 14-45.

Program Elements

• Babies First is available for all pregnant members. Financial incentives are provided for

completing timely and ongoing prenatal, postpartum, and well-baby care, allowing the mother the opportunity to earn gift cards for completing doctor visits for both her infant and herself.

• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provides

comprehensive and preventative health care services for children under age 21; Babies First members may also receive incentives for completing EPSDT visits.

• Reproductive Life Plan: We encourage women of childbearing age to complete a

reproductive health plan which educates members on long-acting reversible contraception as their contraception of choice

• Progesterone Initiative: Program for pregnant members who have been identified as

having a preterm delivery risk. Members may self-refer, be referred by a provider, or are identified by the state’s high risk file. Once identified, members are referred for weekly progesterone injections. All members identified for the progesterone initiative are referred to 1:1 case management.

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Medication Therapy Management

KY Medicaid Services 2020 Humana Services

An Annual Comprehensive Medication Review (CMR) Interactive, person-to-person, or telehealth consultation performed by a pharmacist or other qualified provider for the beneficiary with an individualized, written summary Method of Delivery: Real-time consultation in-person, by telephone or telehealth Recipient: Member and/or authorized individual (caregiver, prescriber etc.) Qualified Provider: Pharmacist, Pharmacist Intern, Physician, Nurse Practitioner, Registered Nurse, Physician Assistant Objective: Review and collect a member’s medications, including prescription, OTC, herbal and dietary supplements that is intended to aid in assessing medication therapy and optimizing patient

• utcomes

Materials provided: Individualized CMR summary in CMS’ standard format that includes: Personal Medication List and Medication Action Plan Targeted Medication Reviews (TMRs) With follow-up intervention when necessary Execution of TMRs (Run Clinical Rules Engine): Assess medication use for potential medication therapy problems Follow-up: Qualified provider will follow-up with member and/or prescriber to resolve potential medication therapy problems Medication Reconciliation With follow-up intervention when necessary Objective: Contact member post-discharge and review/reconcile medication lists and follow up with prescribers for clarification to close gaps Materials provided: written summary of medication list and action plan for the member

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Self-Management Tools

myHealth

• Interactive health assessments, including HRA, which can be

completed in 15 minutes or less.

• Provides personalized guidance and information related to:
• Nutrition and exercise
• Preventive health
• Emotional health
• Safety behaviors
• Tobacco and drug cessation
• Blood pressure, cholesterol, and body mass index (BMI)
• Online tools and dashboards to help members track their health and

wellness goals.

myStrength

• Online resources covering topics such as depression, anxiety, and

substance abuse.

• Provides empowering self-help tools and resources including

parenting tips, mindfulness exercises, weight and stress management.

Population Health anchored by Humana’s Bold Goal

At Humana, Population Health is an enterprise-wide effort with a history in Kentucky.

• Population health is foundational to Humana’s mission that is

advanced by our Bold Goal strategy

• Bold Goal develops programs and partnerships to improve health

and well-being in communities we serve

• Louisville is one of our Bold Goal markets addressing Social

Determinants of Health

NATIONAL THOUGHT LEADERSHIP LOCAL CUSTOMIZATION HEALTHIER POPULATIONS In the last 30 days, how many days have you physically not been well?

1

In the last 30 days, how many days have you mentally not been well?

2

TOTAL

Unhealthy Days

PHYSICALLY

Unhealthy Days

MENTALLY

Unhealthy Days

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Community Engagement

BARRIERS:

Awareness of Resources, Food Insecurity, Transportation

AREAS OF FOCUS:

Diabetes, Respiratory Health, Behavioral Health

Louisville Bold Goal Alignment Louisville 2017 Healthy Days: 12.97

Goal: 10.66 by 2020

WORK GROUPS:

Diabetes – Community Coordination of Care – Behavioral Health – Cultural and Social Impact – Respiratory Health – Communications

Key Partnerships & Sponsorships

• Dare to Care
• March of Dimes
• National Association of Mental Illness (NAMI)
• The Hope Center, Lexington
• Family Resource & Youth Services Coalition of Kentucky
• Daniel Pitino Shelter
• Catholic Charities
• Lexington Rescue Missions

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Questions?

Improving the Health of the Communities We Serve